Is it Right for You?

Almost everyone should be able to get health coverage. The question is, which plan is right for you and your family?

This page looks at whether you might be able to get employer-sponsored coverage. If you can, it is good for you to sign up, because you won’t qualify for other options like MinnesotaCare and subsidized individual coverage.

Many employers offer health coverage as a job benefit, but others do not. Employers are not required to offer this benefit. Contact your employer’s Human Resources department to check.

If an employer offers health coverage as a job benefit for employees, the employer also has to offer the same health coverage to the employees’ children until they turn 26. Note: Dependent children with disabilities can be covered under their parent’s plan, no matter how old the children are. To qualify as a “dependent child,” you must be dependent on your parents for support and unable to support yourself through employment.

If an employer offers coverage to an employee and the employee’s children, they may also let the employee’s spouse join the plan, but they are not legally required to do so.

Example: After you are hired, you have to sign up for your employer-sponsored coverage during your first month on the job. If you don’t, you have to wait until the next open enrollment period to sign up for coverage starting next year.

If your employer, your parent’s employer, or your spouse’s employer offers coverage and you can get that coverage, you probably should. Continue reading this article to learn more about it.

If an employer offers you “affordable” coverage, you do not have some other options

If your employer, your parent’s employer, or your spouse’s employer offers coverage for you that will cost the employee, for the employee’s policy alone, less than 9.5% of your family’s income and that coverage meets bronze-level standards, you will not qualify for MinnesotaCare or government help through tax subsidies to reduce the premium on an individual plan. If you turn down the coverage the employer offers, you will probably not have another affordable option.

Note: The coverage your employer offers must meet affordability standards for the employee, but not for the family. It may be very expensive for family members to join an employer-sponsored health plan. Even so, anybody who could get employer-sponsored coverage, even if it is not affordable for the family member, will not qualify for tax subsidies to buy an individual plan on MNsure or MinnesotaCare.

Other Options for People Who Can Get Employer-Sponsored Coverage

Depending on your situation, you may still be able to get Medical Assistance (MA) if you are offered employer-sponsored coverage. Also, some family members may find that buying an individual plan on MNsure is cheaper than the plan the employer offers, even without government subsidies, or that an individual plan may provide coverage for services that are not covered by the employer-sponsored plan.

Medical Assistance (MA)

Medical Assistance (MA) is a major government-funded health program that helps people with low income. If you qualify for MA, you can get it at the same time as you get employer-sponsored coverage. You may qualify for MA if you are in one of these situations:

MA and Employer-Sponsored Health Coverage

If you qualify for Medical Assistance (MA), it will always be a good choice. However, if your employer, your parent’s employer, or your spouse’s employer offers affordable health insurance, you are required to get it as well. In that case, if MA decides that the plan your employer offers is cost-effective, MA (or MA-EPD) will pay your portion of the monthly premium for the insurance plan your employer offers as well as copayments and deductibles.

This can give you the best of both worlds – you get coverage for your medical needs from both your employer’s plan and MA at a lower cost to you. Here are a couple of reasons to consider having both private and public health coverage:

With private coverage, you may have a wider pool of doctors and other medical service providers to choose from than with public coverage.

If you have employer-sponsored coverage, be sure to list it on your application when you apply for MA. Your county worker will ask you how much you pay for the coverage, and for an explanation of medical benefits to figure out if your coverage is cost-effective.

Nadif is a single father living on his own with his daughter. He makes $10 an hour repairing shoes and works 30 hours a week, so he makes a total of about $1,400 a month. Because he works 30 hours a week, his employer offers him and his daughter health insurance, but to get it, he would have to pay a $200 premium each month.

Nadif decides to go to his local county human services agency to see if his family would qualify for Medical Assistance (MA), because the monthly premium for insurance through his job is really expensive. The caseworker looks at his income and explains that he does qualify for income-based MA, because his income is less than 138% of the Federal Poverty Guidelines (FPG) for a family of 2.

Then, the caseworker says, “Because your employer offers you and your daughter insurance, we need to figure out if the insurance is considered cost-effective. If your employer-sponsored insurance is cost-effective, then MA will pay the premiums and other out-of-pocket costs for you and your daughter.”

Medicare and Employer-Sponsored Coverage

When you first become eligible for Medicare, you’ll automatically be enrolled in Medicare Part A. You’ll also be enrolled in Part B, unless you tell Medicare that you have private coverage. If you already have employer-sponsored private coverage that covers the same things Part B covers, you avoid paying Part B’s monthly premium. You can always sign up for Part B later without paying a penalty as long as your private coverage meets certain requirements.

You can also choose not to get Medicare Part D. As long as your current private coverage is creditable, which means that it is at least as good as the Part D benefit, you can sign up for Part D at a later time without paying penalties.

Depending on your situation, you might get employer-sponsored coverage, MA, and Medicare all at the same time. This can sound confusing, but it can help you, because one form of coverage may pay for costs that your other coverage won't pay for.

The rules about how your different types of coverage pay for things are very complicated, so it’s important to check with your health coverage plans when you have questions about which plan will pay for what expenses.

Union and Association-Sponsored Group Coverage

Some people who are self-employed may not be able to get employer-sponsored group coverage, but could get group coverage through unions or professional associations. Speak to your union or association representative to learn if this is an option for you.

Note: Starting in 2014, anybody can sign up for individual health coverage on MNsure. Look into MNsure, where you may qualify to get government help paying for individual coverage though tax subsidies. You cannot get this government help for a union-sponsored or association-sponsored plan.

Tools on This Page

Glossary

The portion of the payment for medical services that an individual is responsible for. For example, your health coverage may pay for 80% of the costs of a service, while you will have to pay the remaining 20%. That 20% is known as "co-insurance."

A set amount you have to pay when you receive medical services. For example, you may have to pay $30 every time you visit the doctor or $20 to get a prescription refilled. This is also known as a "copay."